包皮内板游离皮片结合Orandi皮瓣重建尿道治疗闭锁性阴茎段尿道狭窄的疗效和可行性  

The efficacy and feasibility of free inner prepuce graft combined with Oradi flap urethroplasty for the treatment of the obliterated penile urethral atresic stricture

作　　者：杨运运 宋鲁杰[1] 梁涛[1] 张楷乐[1] 谷遇伯 杨冉星[1] 张炯[1] 傅强[1] Yang Yunyun;Song Lujie;Liang Tao;Zhang Kaile;Gu Yubo;Yang Ranxing;Zhang Jiong;Fu Qiang(Department of Urology,Shanghai Jiao Tong University affiliated Sixth People’s Hospital,Shanghai Eastern Institute of Urologic Reconstruction,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海东方泌尿修复重建研究所,200233

出　　处：《中华泌尿外科杂志》2021年第10期768-772,共5页Chinese Journal of Urology

摘　　要：目的探讨采用包皮内板游离皮片结合阴茎侧方带蒂皮瓣(Orandi皮瓣)重建尿道治疗闭锁性阴茎段尿道狭窄的疗效和可行性。方法回顾性分析2016年1月至2019年9月上海交通大学附属第六人民医院收治的18例闭锁性阴茎段尿道狭窄患者的临床资料。平均年龄62.1(20~81)岁。生活质量(QOL)评分4.6(4~6)分。术前10例已行耻骨上膀胱造瘘。8例未造瘘患者最大尿流率4.2(1.6~6.2)ml/s。手术采用全麻,患者取截石位。取阴茎腹侧纵行切口,暴露尿道并纵行切开狭窄段。术中测量狭窄段长度为5.0(2.0~7.5)cm。充分切除瘢痕组织后,采用包皮内板皮片结合Orandi皮瓣修复。根据狭窄段长度和宽度取包皮内板背侧全厚游离皮片,长度5.1(2.0~7.5)cm,宽度1.4(1.2~1.8)cm,移植重建背侧尿道板;尿道腹侧采用Orandi皮瓣加盖,Orandi皮瓣取材长度6.0(2.2~7.7)cm,宽度1.3(1.0~1.5)cm。留置F14~16硅胶尿管,术后3~4周拔除尿管。于术后3、6、12个月及每年进行随访,包括主诉、尿流率,必要时行尿道造影和软性尿道镜检查。结果本组18例手术均顺利完成。术后随访29.1(15~54)个月。术后3个月复查,18例均排尿通畅,最大尿流率25.3(15.3~38.2)ml/s。术后3、6个月QOL评分分别为0.8(0~2)分和0.6(0~1)分,与术前比较差异均有统计学意义(P<0.05)。5例术后1年内出现排尿滴沥,排尿不尽感;4例术后6个月内出现反复泌尿道感染,应用抗生素治疗有效。结论包皮内板游离皮片移植结合Orandi皮瓣加盖是修复闭锁性阴茎段尿道狭窄的有效方法,尤其适合不愿或不宜取口腔内黏膜的患者。包皮内板游离皮片替代尿道具有取材方便、操作简单、并发症少的优点。Objective To investigate the efficacy and feasibility of urethroplasty using inner prepuce graft combined with Orandi flap for the treatment of the obliterated penile urethral atresic stricture.Methods From January 2016 to September 2019,the clinical data of 18 obliterated penile urethral stricture cases were analyzed retrospectively.All the patients were treated using inner prepuce flap combined with Orandi Flap.The average age of the patients was 62.1 years old(range 20-81 years old).Ten cases had suprapubic cystostomy before operation.The maximum flow rate was 1.6-6.2 ml/s,with an average of 4.2ml/s.The intubation general anesthesia and lithotomy position was used.The foreskin of penis was incised longitudinally.The urethra was exposed and the segment of stricture was opened longitudinally.The range of stricture length was measured with soft ruler,ranging from 2.0 to 7.5 cm,with an average of 5.0cm.After the fibrotic tissue was completely removed,the dorsal inner prepuce was incised with needed length and width for harvesting a free skin flap in order to transplant and reconstruct the dorsal urethral.The Orandi flap was used to cover the ventral urethra,and a F14-16 silicone catheter was retained.The length range of the inner prepuce graft was 2.0-7.5 cm,with an average of 5.1cm;the width was 1.2-1.8 cm,with an average of 1.4cm.The length of Orandi flap was 2.2-7.7 cm,with an average of 6.0cm;the width was 1.0-1.5 cm,with an average of 1.3 cm.The catheter was removed 3-4 weeks after operation.The patients were then followed up after 3,6 and 12 months postoperatively and then with annual assessments for the symptoms,urinary flow rate,and urethrography or soft urethroscopy when necessary.Results All of the 18 operations were completed successfully.The patients were followed up for 6-36 months,with an average of 22 months.There were 5 patients with terminal dripping,4 patients with recurrent urinary tract infection within half a year after operation,and antibiotic treatment being effective.The quality of life sco

关 键 词：尿道狭窄 闭锁性阴茎段尿道狭窄 包皮 皮瓣 尿道成形术 

分 类 号：R699[医药卫生—泌尿科学]